Message from the president

Jeffrey Richardson, MD, President

The day before Thanksgiving (seems so long ago…) I met a lovely, intelligent, young woman physician from Ethiopia. Only in America can you find these opportunities. Our service men and women are in many dangerous places in the world during the holidays to preserve the rights and freedom of Americans and preserve the wonderful opportunities America provides to people from countries where they would never have the chance to develop their full potential. Much to be thankful for. Show gratitude to those who serve and sacrifice so bravely and to their families.

As we start a new year, physicians must be prepared and start to look at themselves and their profession in a new light. The recent MTA strike in LA and the grocery workers strikes are purportedly over the high cost of health care and whether the employer or employee will bear some or all of that cost. There is no question that health insurance and health care costs are rising. Where the new revenue is going is another question. I am not seeing it and I’m sure you are not seeing it. Medicare, MediCal, and insurance reimbursements have been going down or at least not keeping up with the CPI. Real dollars (after down coding, denials, delayed payments, etc.) are much lower. Our government leaders and population do not see the big picture. A national nursing shortage, a shortage of doctors in the inner city, and declining medical school enrollments are not solved by admitting more people to school or bringing in unlicensed doctors from third world countries. They will just change professions or drop out for better opportunities like those currently are doing. The solution is to provide better working conditions, pay, benefits, and respect for those in the profession and this will entice more good people to want to go into health care. Something is wrong when longshoreman, MTA mechanics, and bench sitting under performing athletes make more than many physicians and nurses.

For many years we have all heard the criticism that doctors are not good businessmen. Under Nixon and his successors it was felt that opening medicine up to the free enterprise/market system would result in competition bringing prices down. We all know that the result of this was to let a lot of greedy, unethical businessmen develop HMO’s, surgical center chains, pharmaceutical companies, medical management companies, among others that have driven healthcare prices higher and higher without measurable benefit, but yet, we physicians take the blame. It is time we become better businessmen.

Physicians must realize that the world is different. Many groups are out there who want to take your profession away from you but don’t want to do the work to gain the knowledge required. Pharmacists want to prescribe as do nurses. Podiatrists want to operate on the knee. Psychologists want to prescribe and do inpatient care. Nurse anesthetists, nurse practioners and midwives want to practice independently and unsupervised. Optometrists want to prescribe and do laser surgery. None of them want to take additional training. Hospitals want to compete with the physicians’ bread and butter and buy up doctor’s practices to gain control of the outpatient market. HMO’s want to collect premiums and process claims but pass all of the insurance risk on to physicians. Government is bought off by these special interests and lets physicians flounder by not enforcing the laws.

It is time physicians direct their own destiny. They must think of their profession as an industry and band together as a force politically and socially. Too many physicians want to sit in the doctors’ lounge grousing and complaining about the current state of affairs but don’t want to take any action to help themselves. No one will do it for them. We are great advocates for our patients. They are not great advocates for us. Organized medicine has a pejorative meaning to many doctors. We must change that. We must ensure that our medical organizations aggressively, actively, and appropriately represent us to government agencies, the courts, and the public as never before. We must work together as a profession and not be splintered by our own special interests. Compromise is essential.

The Ventura County Medical Association, California Medical Association, American Medical Association, and specialty societies are doing a much better job advocating for us. More needs to be done. Most of all, we need to get the majority of the physicians, the grousers and complainers and do nothingers to understand it is time to stand up, act, and be counted even if it just means being a joiner. There will be many issues that divide us, but even more that are crucial to our survival that we can agree on and act on. Make 2004 the year you resolve to become proactive and get your colleagues to do the same.

I hope you, your families, and patients have a healthy and happy 2004.